Truvada for PrEP*
Take a missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Truvada should not be used for prevention if CrCl or eGFR (measures of kidney function) is less than 60 mL/min. (Note: this is different from Truvada for HIV treatment.)
- Generic is available.
- See the individual drugs contained in Truvada: Viread and Emtriva
- See package insert for more complete information on potential side effects and interactions.
gilead.com; truvada.com
(800) GILEAD-5 (445-3235)
generic: $2,100.20/month
JO-ANN JOSE, MD, MPH:
Truvada is the most affordable option for PrEP right now because it’s available as a generic. Potential kidney and bone density side effects are associated with Truvada because it contains TDF (tenofovir disoproxil fumarate), the older version of the HIV drug tenofovir, compared to Descovy, which contains the newer TAF (tenofovir alafenamide) formulation. For many people who would like to access PrEP, but for whom pricing is an important consideration, Truvada would be most cost-effective for HIV prevention. It was studied in a variety of populations and works very well if adherence is maintained. Truvada for PrEP is intended to be taken daily; however, there are other ways of taking it. You should talk with your doctor if that is of interest.
Do not take with any other HIV or HBV drugs (including Vemlidy, or TAF) when using Truvada for PrEP. Avoid taking Truvada with drugs that negatively affect the kidneys, including chronic use or high doses of anti-inflammatory drugs for pain like Advil or Motrin (ibuprofen) and Aleve (naproxen). Truvada for PrEP can be used with the hepatitis C drugs Daklinza, Harvoni, Sovaldi, Olysio, Viekira Pak, or Zepatier. Truvada should not be given with adefovir. Monitor for tenofovir toxicities if used with Epclusa. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not.
No new serious side effects were observed when Truvada was studied for HIV prevention in clinical trials. Some people may experience nausea, headache, stomach pain, or weight loss. Risk compensation (when people put themselves at greater risk for infection, such as anonymous or multiple sex partners, because they think PrEP will protect them) was not observed in clinical trials. The tenofovir DF (Viread) in Truvada is associated with long-term decreases in bone mineral density (BMD). BMD monitoring should be considered in people who have a history of bone fracture due to a disease or are at risk for osteopenia or osteoporosis. Truvada can cause kidney toxicities. In prevention studies, decreases in BMD and creatinine clearance or eGFR (a marker of kidney function) were rare, mild, and usually reversible upon stopping Truvada. In adolescents, however, BMD-z scores (which compare bone growth to that of matched peers) did not return to baseline. Tell your provider about pain in extremities, persistent or worsening bone pain and fractures, with or without muscular pain or weakness, as well as any concerning changes in urinary habits as these could be signs of bone or kidney problems. If Truvada is discontinued abruptly in people with hepatitis B virus (HBV), flare up of hepatitis may occur—talk to your provider before discontinuing. In studies, there were cases of people who had unidentified HIV infection when starting Truvada for PrEP and subsequently developed drug resistance. A negative HIV test must be confirmed immediately prior to starting Truvada for PrEP. Truvada alone is not a complete regimen to treat HIV. Continuing only with Truvada after acquiring HIV may lead to drug resistance and limit future antiviral options. Truvada contains lactose, which can cause some abdominal discomfort, especially in people who are sensitive to lactose. Truvada for PrEP may cause some weight loss.
Truvada for PrEP is 99% effective in preventing HIV when taken daily as recommended. Stigma and lack of access to health care continue to fuel HIV infections. Individuals should be tested for HIV infection at least every 3 months while taking Truvada for PrEP. CDC PrEP guidelines list non-daily dosing that can be used. This includes PrEP on demand: two pills 2–24 hours before sex followed by one pill 24 hours later and another pill 48 hours later (also called 2-1-1 or intermittent PrEP; GO TO cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf, SEE pages 55–57). Remember, risk depends on the situation—including where you live. Other problems include not knowing about PrEP and inability to perceive a need for it (not realizing one may have vulnerabilities at all). Although the drug label specifies prevention of sexually-acquired infection, U.S. HIV guidelines also recommend use for protecting against infection through injection drug use (reducing the risk of HIV by more than 70%, according to the CDC). The label notes that risk includes a number of behavioral, biological, or epidemiological factors, including condomless sex, current or past STIs, self-identified risk, having sexual partners of unknown HIV status or unknown HIV viremic status, or sexual activity in a high prevalence area or network. Screening and monitoring requirements include checking for STIs and for hepatitis B and C. Insurers must cover PrEP and its associated services (such as STI testing) without cost (such as co-pays) to people, but the details of coverage can vary and there was a significant legal challenge at the time of publication. The National Alliance of State and Territorial AIDS Directors (NASTAD) developed a guide to help providers bill for PrEP services, available at nastad.org/resource/billing-coding-guide-hiv-prevention. GO TO nastad.org/prep-access for an FAQ. Two excellent websites for finding a PrEP provider are preplocator.org and aidsvu.org—although any provider can prescribe PrEP. Gilead Sciences helps people work with their insurance, including pre-authorizations, as well as provides free PrEP to uninsured people who are eligible, and co-pay assistance up to $7,200 a year; contact the patient assistance hotline 24/7 at (877) 505-6986, or GO TO gileadadvancingaccess.com. On-demand PrEP with Truvada, which uses four tablets around the time of sex, is supported by guidelines from the International AIDS Society-USA, the European AIDS Clinical Society (EACS), and the World Health Organization. Truvada generic became available in the U.S. in October 2020. SEE discussion online of the generic’s pricing (positivelyaware.com/articles/briefly-novdec-2020 and positivelyaware.com/articles/briefly-jul-aug-2017). HHS HIV guidelines have a section on using PrEP for periconception, antepartum, and postpartum periods. PrEP Facts: Rethinking HIV Prevention and Sex is a closed Facebook group for people interested in or currently on PrEP, and their allies. For more information, GO TO cdc.gov/hiv/basics/prep.html. Pregnant individuals can voluntarily enroll in the Antiretroviral Pregnancy Registry through their provider; GO TO apregistry.com.
JUAN MICHAEL PORTER II:
Truvada remains a wonderful HIV prevention drug for millions of people around the world. In 2024, Raphael Landovitz, MD, told me that it provides sufficient protection to women and other people with vaginal tissue after only one week, instead of the 21 days recommended by HHS guidelines. On demand Truvada can also be used by cisgender men and trans women (in a 2-1-1 sequence). However one deploys it, consistent use is really important if it is to be effective.